Sleep has been increasingly seen as important in health. More so than anything else. More so than good food, exercise, social connections, environment, everything. Everyone knows sleep is important, but is it even considered in hospitals?
When I was in the physical health hospital, sleep was essentially not considered. Night time medications were scheduled for 10pm. Observations were done 4 hourly, often throughout the night for most patients. Occasionally, this is necessary, but for those who have been stable and healthy, is it better to interrupt their sleep, or is it better to take observations? Things like blood pressure cuffs can be uncomfortable, the observations machines can be noisy, they have bright lights too sometimes. This wakes up not only the patient, but can wake up people around them.
Imagine having a blood pressure cuff squeeze your arm at 2/3/4am. We wouldn’t be well rested or happy in the morning either. If this did happen to us one time, we could forgive it, we could sleep well the next night and things would be okay. But, imagine this happening every night during your entire hospital stay? Sometimes weeks, months. Imagine on top of this, having injections into your belly every day, sometimes twice a day. People get bruises, they say the injections are painful. Some of these people are mobile, some of these people don’t really need the injections to prevent a blood clot.
It’s all a painful process. It’s tiring. It’s not always the kindest. Hospitals are the worst places to sleep. Most don’t have side rooms. Most hospital wards are quite noisy places. I remember once going to a ward on a night shift at 3am, and the staff were playing the radio on full blast to keep them awake. I thought it was mad. I understand the need to stay awake is tough, especially on a night shift, but I think the benefits and importance of sleep are simply overlooked.
And then, when you get to 6am, the incredibly bright hospital lights are all turned on, and the day starts. But, the lights aren’t turned off until at least 10pm, at least after the final night medications round are done. People think 10pm to 6am is enough time, they should sleep 8 hours. But, we all know that’s not true. Going to bed at 10pm means actually going to sleep at maybe 10:15-10:30pm, at best. That’s in the sanctuary of home. That’s when you don’t have extra thoughts or stresses keeping you up. That’s when you’re not in hospital and ill! I know ill people are more sleepy, as their bodies need more rest, but they still have thoughts and stresses, which they can’t necessarily deal with in the same way they would do at home.
Then, you get woken up at 6am with the lights, the observations, the medications round. Interrupted sleep isn’t the same as continuous sleep. It is not as good. It does negatively impact your health. I just think patients are not getting 8 hours of sleep in the hospital, there is no way. Most of them are not, I guarantee it if you put a sleep tracker on them. It is maybe 5-6 hours at most. And the effects of this compound with each night. Continuously sleeping 5-6 hours is horrendous for your health, puts you at risk for a whole host of health conditions.
People who have an extended hospital admission must have an increased incidence of health conditions in the future. I don’t have the evidence myself, I admit. But, after working in the hospital, especially on the adult wards, it just did not seem like as much of a place of healing, as I initially thought hospitals were. Seeing patients over an extended hospital stay was what made me realise this. Seeing them towards the end of their weeks-months long stay was difficult. They couldn’t wait to go home, to actually rest. To be themselves again.
I know we do lots of incredibly good things in hospital for people’s health, we do save lives, I’ve seen that first-hand. We do it through complicated medications and methods sometimes. But, I do think the simple things need looking at in the NHS. Sleep, better meals (who loves hospital meals? Nobody!), more exercise and activities to keep them engaged, more time outdoors, etc. The simple things. The ‘non-medical’ things. The preventative things.
Once, a patient on a night shift begged me for an eye mask and ear plugs. It was my first night shift, so I thought it was a perfectly reasonable ask, and when I asked one of the staff for this, they snorted at me, and said it wasn’t a hotel. I think eye masks and ear plugs in hospital would be incredibly beneficial. On every ward, for every patient. People will sleep more, and get better sooner! I don’t have the evidence, I don’t have a study, I haven’t yet run a quality improvement project, but maybe I will try.
Now, in the mental health hospital however, things are different. Sleep is considered. Sleep charts are kept for some patients. They each have their own bedrooms. It’s private, it’s more like a proper bed. They have curtains, they aren’t awoken at 6am for medications. They have a ‘normal’ start to the day at 8-9am. Their morning routines are attempted to be recreated, whatever habits that may entail. They have a ‘normal’ wind down at the end of the day after having dinner at 6pm. It feels like a weird luxury to be here. To see this happen. It does feel more like a hotel in that sense. The patients have more freedom, more activities to keep them engaged, an outdoor area they can access at any time if they wish. People to talk to them.
Overall, sleep is considered as an actual important factor in the mental health hospital. Medications are optimised for this and their environments are too. If they didn’t sleep well one night, that is taken into account. Whereas, it was never really considered in the physical health hospital. Sleep is good for mental health, but it is also good for physical health. Sleep is healing.